Howard T P, Solomon D A
Department of Internal Medicine, University of South Florida College of Medicine, Tampa 33612.
Arch Intern Med. 1988 Nov;148(11):2457-9.
A prospective study of 806 healthy volunteers was carried out to determine the value of induration 24 hours after placement of purified protein derivative, if patients can accurately read their own tests, and if the pen and palpation methods are comparable. Subjects were actively employed health workers between 20 and 64 years of age without active tuberculosis. All subjects were tested using 5 tuberculin units of purified protein derivative via the Mantoux technique. Induration was quantitated by trained readers at 24 hours and at 48 to 72 hours. Patients were asked to read their own tests as well at 48 to 72 hours. The amount of induration at 24 hours was highly predictive of eventual findings at 48 to 72 hours. The patients' abilities to read their own tests were poor. Significant differences were noted between the pen and palpation methods. The degree of induration noted 24 hours after placement of 5 tuberculin units of purified protein derivative is valuable in a screening population. Most decisions, however, should still be based on results measured at 48 to 72 hours. Results with the pen technique must be interpreted with caution in the 5- to 14-mm range. The patients' readings of their own results are inaccurate and should never be relied on to make clinical decisions.
对806名健康志愿者进行了一项前瞻性研究，以确定在接种纯化蛋白衍生物24小时后的硬结情况是否有价值，患者是否能够准确读取自己的检测结果，以及笔式和触诊法是否具有可比性。研究对象为20至64岁无活动性结核病的在职卫生工作者。所有受试者均通过曼托试验法使用5个结核菌素单位的纯化蛋白衍生物进行检测。硬结情况由经过培训的阅片者在24小时以及48至72小时进行测量。患者也被要求在48至72小时读取自己的检测结果。24小时时的硬结情况对48至72小时最终的检测结果具有高度预测性。患者读取自己检测结果的能力较差。笔式和触诊法之间存在显著差异。接种5个结核菌素单位的纯化蛋白衍生物24小时后的硬结程度在筛查人群中具有参考价值。然而，大多数诊断仍应基于48至72小时时的检测结果。笔式检测法在5至14毫米范围内的结果解读时必须谨慎。患者自行读取的检测结果不准确，绝不应该依赖其结果来做出临床诊断。
